Tackling chikungunya and dengue crisis in Paraguay amidst COVID-19: an epidemiological alert – a correspondence
Authors: Safi ur Rehman Sadiq, Stanley C. Eneh, Abubakar Nazir, Mubarak J. Mustapha, Faizan Saleem, Awais Nazir, Olivier Uwishema
Journal: International Journal of Surgery (2023)

Chikungunya is a viral disease. This disease is caused by the chikungunya virus. This virus is transmitted through the bites of infected mosquitoes. The most significant symptoms of chikungunya virus infection are fever and joint pain, which are usually debilitating1. The duration for which pain occurs varies among individuals. Headache, muscle pain, nausea, rashes, and joint pain are some of the other symptoms associated with this viral infection1. These symptoms of chikungunya infection are similar to those of dengue and Zika infections; thus, these similar infections are frequently confused in areas where these diseases coexist. Chikungunya infection is rarely severe and does not result in death1. However, the current surge in chikungunya cases amid the spread of the dengue virus is alarming. In Paraguay, both diseases with similar patterns, dengue and chikungunya, are on the rise. An increasing number of both dengue and chikungunya cases was reported in 2022. So far, 1839 cases of dengue have been reported in 20222. The total number of cases of chikungunya was reported in 2022, although less than that of dengue, has reached 531 as of 1 December 20222. Paraguay is a landlocked country. It is situated in the center of South America. Paraguay is bordered by Brazil, Argentina, and Bolivia. The first reported case of chikungunya fever in Paraguay dates back to 2014. In 2014, all the reported cases were imported to Paraguay. The first outbreak of chikungunya in Paraguay occurred in 2015. A similar epidemic occurred in 2016 as well. The outbreak of chikungunya in Paraguay that occurred in 2017 was milder than that which occurred in 2016. This can be explained by improvements in vector control interventions after the previous outbreaks. Every year since its introduction into Paraguay, a seasonal outbreak of chikungunya has occurred until 2018. All these outbreaks were accompanied by a rising number of cases of dengue infections3. Thus, both of these diseases have been occurring at the same time. Paraguay has faced a big burden from coronavirus disease 2019 (COVID-19) infections, with the total number of reported cases being 778 000 and the total number of deaths being 19 6304. Currently, the incidence of chikungunya infections has been on the rise in Paraguay. This increase in the number of chikungunya infections should be investigated by screening programs and surveillance, but due to the current COVID-19 pandemic, all the efforts are to control COVID-19 infections. Moreover, the staff that was supposed to be appointed to provide healthcare facilities related to other public health issues is directed to control COVID-19 infections5. Moreover, there is a diversion of funds to control the COVID-19 pandemic. Previously, these funds were to be used to provide public healthcare facilities5. Thus, the COVID-19 pandemic has led to a lack of healthcare facilities by reducing the number of available healthcare staff and reducing the provision of medical facilities. Climate change plays an important role in the spread of chikungunya infections6. Since this disease is caused by a virus that is transmitted via the bite of an infected mosquito, climate change is very important for the growth of mosquitoes and the spread of the Chikungunya virus by these mosquitoes. Another factor responsible for the spread of chikungunya is the nonavailability of the vaccine against it6. Thus, all the above-mentioned factors are responsible for the increase in the number of chikungunya cases in Paraguay. Chikungunya viruses have had a significant negative impact in Paraguay, such as on public health and economic adversities7. Effective measures are therefore needed to manage existing cases and prevent further ones. One of the factors causing the increased spread of the Chikungunya virus in Paraguay is the lack of important details on the season of the illness and the genetic diversity of the spreading viral lineages7. Thus, there should be a proper study of the arbovirus. This is essential for supporting healthcare organizations with readiness because it provides important details about the periodicity of illnesses and variations of circulating viral lineages. Where resources allow, this monitoring can also include genome monitoring using portable sequencing technologies. It was effectively utilized to research the Chikungunya virus outbreaks in numerous Brazilian provinces8, the resurgence of yellow fever in Brazil9, and the Zika virus outbreak in the Americas10. Furthermore, immigrants should be tested for the Chikungunya virus before entering Paraguay to prevent them from spreading the virus to other uninfected people if they are infected. Also, there should be an adequate number of professionals and facilities for the proper testing of individuals. Preventative measures should be taken to curb the spread of the Chikungunya virus in Paraguay. There should be public enlightenment on the importance of protecting oneself from mosquito bites using efficient methods such as the use of insect repellants, wearing long-sleeved shirts and pants, treating clothes, using mosquito nets properly, and taking other steps to control mosquitoes indoors and outdoors10. Finally, further research should be done on chikungunya in Paraguay to develop better means of its management there. Ethical approval Not applicable. Sources of funding Not applicable. Author contribution A.N.: conceptualization and project administration; A.N., S.C.E., S.R.S., M.J.M., F.S., and A.N.: original manuscript writing; S.C.E.: second draft and writing – review, editing, and final draft. All authors were involved in the final approval of the manuscript. Conflicts of interest disclosure There were no conflicts of interest. Research registration unique identifying number (UIN) None. Guarantor Name: Abubakar Nazir; Affiliation: Oli Health Magazine and Organization, Kigali, Rwanda; E-mail: [email protected]; ORCID ID: 0000-0002-6650-6982.